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Measuring the impact of non‐monetary incentives on facility delivery in rural Zambia: a clustered randomised controlled trial
Author(s) -
Wang P.,
Connor A. L.,
Guo E.,
Nambao M.,
ChandaKapata P.,
Lambo N.,
Phiri C.
Publication year - 2016
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12678
Subject(s) - medicine , health facility , incentive , cost effectiveness , logistic regression , environmental health , randomized controlled trial , psychological intervention , population , nursing , surgery , health services , risk analysis (engineering) , economics , microeconomics
Objectives In Zambia, only 56% of rural women deliver in a health facility, and improving facility delivery rates is a priority of the Zambian government. ‘Mama kit’ incentives – small packages of childcare items provided to mothers conditional on delivering their baby in a facility – may encourage facility delivery. This study measured the impact and cost‐effectiveness of a US $4 mama kit on rural facility delivery rates in Zambia. Methods A clustered randomised controlled trial was used to measure the impact of mama kits on facility delivery rates in thirty rural health facilities in Serenje and Chadiza districts. Facility‐level antenatal care and delivery registers were used to measure the percentage of women attending antenatal care who delivered at a study facility during the intervention period. Results from the trial were then used to model the cost‐effectiveness of mama kits at‐scale in terms of cost per death averted. Results The mama kits intervention resulted in a statistically significant increase in facility delivery rates. The multivariate logistic regression found that the mama kits intervention increased the odds of delivering at a facility by 63% ( P ‐value < 0.01, 95% CI : 29%, 106%), or an increase of 9.9 percentage points, yielding a cost‐effectiveness of US $5183 per death averted. Conclusions This evaluation confirms that low‐cost mama kits can be a cost‐effective intervention to increase facility delivery rates in rural Zambia. Mama kits alone are unlikely to completely solve safe delivery challenges but should be embedded in larger maternal and child health programmes.